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Causes of back pain

Knowing what causes back pain is a big step towards preventing back pain and controlling back pain when it occurs.

We now know that psychological and even social factors play an important role.

Back pain can originate from various structures in the back. Sometimes the exact location of where the pain comes from can be found while in other cases it is less clear where the pain originates.

Irrespective of where in your back the pain is coming from, the question is what actually caused this pain and what can I do to prevent the pain from becoming worse or re-appearing. The list of factors that may contribute to back pain is long. Not all these factors are physical factors and we now know that psychological and even social factors also play an important role. Some of these possible causes may be surprising, but are nevertheless important if we want to understand and control back pain.

Where does my pain come from?

As explained in 'About your back' your back consists of many different structures that all have to work together. You may think that any abnormalities in the structure or functioning of your back result in pain, but this is not necessarily true. People have very different backs and it is difficult to define a 'normal' structure. Some people with severe deformities may not experience any back pain while others who appear to have 'normal' backs experience severe pain.

'In most cases scans, such as X-rays and MRI's, cannot show where back pain comes from'

This is why medical imaging such as an X-ray, MRI scan or CT scan is not necessarily an appropriate method of assessing back pain. Nowadays your GP or consultant will only use these scans when he or she thinks that your back pain is associated with a certain structural abnormality in your spine. This is only the case in a minority of the people with back pain. In most cases scans and test show no clear explanations for the pain. It should be noted though that even although the exact cause of the pain may be difficult to identify, the pain is real and fortunately there are a number of options when treating this type of back pain.

In some cases the back pain can be traced to a specific cause, for example:

Muscle sprain: sometimes you can ‘pull a muscle’ in your back, resulting in a small tear or sprain in your muscle.

Disc protrusion: sometimes the discs between the vertebrae may become weaker and bulge out. In an extreme case this may lead to a prolapsed disc.

Prolapsed disc (‘slipped disc’ or ‘herniated disc): Sometimes a disc bulges so far out that it puts pressure on the spinal nerves running in your back. You may feel this as pain in your legs (sciatica) since these nerves in your lower back run all the way down to your legs.

Spinal stenosis: the spinal column runs through a narrow opening in your vertebrae. If this opening becomes too narrow the nerves may become trapped, which causes pain.

Collapsed vertebra: the vertebrae give much of the structural support to the spine but these may become damaged as a result of disease or injury. Severe osteoporosis may result in a vertebra collapsing and by doing so disturb the surrounding structures.

The above causes may explain where the pain originates, but may not necessarily explain the degree of pain. This is where the risk factors that are discussed below may play a role.